Provider Demographics
NPI:1437189347
Name:LAU, MICHAEL PH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PH
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7500 212TH ST SW
Mailing Address - Street 2:#210
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7641
Mailing Address - Country:US
Mailing Address - Phone:425-771-3311
Mailing Address - Fax:425-775-9844
Practice Address - Street 1:7500 212TH ST SW
Practice Address - Street 2:#210
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7641
Practice Address - Country:US
Practice Address - Phone:425-771-3311
Practice Address - Fax:425-775-9844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00018013207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1196906Medicaid
WAA09145Medicare UPIN
WA1196906Medicaid